Instruments generally known as laryngoscopes are routinely used to facilitate endotracheal intubation of patients, e.g., to provide a temporary air passage for administration of anesthetic substance or to overcome an obstruction of the air passage to a patient's lungs. Laryngoscopes, in various forms, are also commonly used in surgery to displace oral cavity and pharyngeal tissues to enable a surgeon to perform direct inspection and surgical manipulation of a patient's larynx, a procedure known as direct laryngoscopy. The typical laryngoscope has an elongate portion, which may be of adjustable geometry, that is introduced through the patient's mouth into the larynx. An attached handle enables the surgeon to manipulate not only the portion introduced into the patient's larynx but, as appropriate, to position the distal end of the inserted element to perform inspection and/or surgical operations. One or more surgical tools may be inserted simultaneously via the inserted element. Otolaryngologists typically use a laryngoscope having a tubular portion insertable into the patient's larynx to the glottis, i.e., the true vocal cords or folds, both for viewing and for endoscopic surgical operations thereon.
The surgeon must have a clear view of the affected tissue and must be able to perform precise surgery, sometimes with more than one tool utilized simultaneously. Because of the limited dimensions of the human oral cavity, pharynx and larynx, and the inevitable discomfort suffered by the patient in such a procedure, it is extremely important to enable the surgeon to have the widest access and maximum freedom for manipulating necessary instrumentation, and to reduce the time during which physical invasion of the patient's larynx must occur.
Particularly for patients who need to improve or maintain their voices, specialized surgery known as phonomicrosurgery is performed with the use of a surgical microscope. Such phonomicrosurgery is optimized by obtaining the widest glottal surgical field to expose vocal-fold anomalies such as polyps, nodules, cysts, granulomas, papilloma, epithelial dysplasia, and cancerous growths.
The human vocal folds (glottis) comprise an approximately isosceles-triangle-shaped valve that is fixed anteriorly and opens and closes posteriorly to allow for respiration and phonation, respectively. Lesions of the vocal folds may occur in patients of all ages and of both genders. A clear human voice is predicated on aerodynamically-driven, symmetrically-entrained oscillation of the vocal folds. When the vocal folds are closed during phonation, the expired air stream from the trachea is opposed by the closed glottal valve. Under sustained aerodynamic pressure, the vocal folds will vibrate to generate phonation. This vibration becomes disordered, and hoarseness develops, if there is a lesion on the vocal folds. Most benign lesions of the vocal folds, except lesions caused by viral infection, tend to develop in vocal over-users.
Successful phonomicrosurgery depends on maximal preservation of the layered microstructure of the healthy vocal fold tissue and is facilitated by the largest appropriately-shaped laryngoscope that can be placed between the patient's lips and glottis. Accordingly, the optimal laryngoscope will be one which facilitates ideal exposure of the pathology and, in turn, hand-instrument examination and retraction of the lesion for examination and resection.
In the known prior art, the problem of effectively angulating hand-held and operated instruments within the lumen of the laryngoscope element inserted into the patient's mouth and larynx was solved in two ways: by forming the lumen structure to have a widened proximal aperture of a tubular laryngoscope or, in the alternative, by using a bivalved spatula laryngoscope comprised of two pivotably separable distending spatula blades. The latter tends to be unstable distally away from the distending mechanism. A single slot was sometimes provided in the lumen to facilitate manipulation of proximal end portions of surgical instruments therein, but this provided room for instrument manipulation on only one side of the laryngoscope. The prior art furthermore suffers from an inability to provide the dimensional versatility required when treating patients of differing anatomy.
A need exists for a modular glottiscope system which enables a surgeon to treat patients of different sizes, permits access to specific portions of the larynx with greater precision and comfort for the patient, and permits flexibility in manipulation of one or more viewing and/or surgical tools and, because of its modular variations, easily adapts for intubation applications. The present invention is intended to meet all of these needs.